Evidence-based pathways to modernise emergency nursing in Italy: autonomy, accountability, and outcomes

Italian emergency nursing has not evolved in step with rising Emergency Department (ED) demand and increasing clinical complexity, contributing to overcrowding, delays, burnout, and inappropriate ED use. This paper synthesizes European models and evidence to outline a modernization agenda centred on professional autonomy, accountability, and outcomes. We propose implementing Advanced Nurse Practitioners to manage low- to moderate-acuity presentations through urgent care pathways, supported by master’s education and a clear scope of practice with audit. For prehospital care, we recommend an advanced practice profile for out-of-hospital emergency nurses enabling assessment, protocolised treatments, non-conveyance decisions, and activation of general practitioner and community services when chronic-care pathways are appropriate. System levers include adoption of a validated national triage system with training and recertification, reconfiguration of night-time demand via alternative community access and telehealth, and investment in nurse-led research networks and university pathways. Finally, competencies and responsibilities should be linked to contractual recognition, remuneration, and sustainable rostering. These actions aim to reduce inappropriate ED attendance, shorten call-to-treatment times, improve patient safety, and strengthen workforce retention, aligning Italy with European standards in emergency care.